A cataract is a development of an opaque or clouded region in the crystal lens of the eye. Generally, the deterioration process is not reversible. The typical current treatment is to remove the cataract material completely. After the surgery, artificial lenses are provided to facilitate vision. Such lenses may be of a variety of types, including extraocular eye frames and lenses, extraocular contacts, and intraocular contact lens devices.
Recently, various microsurgery techniques have been developed to enable easier removal of the cataracts. One frequently used method is phaeco-emulsification. For application of this process, a small incision is made in the eye, and a probe, generally a titanium needle, is inserted therethrough. The probe includes a tip which vibrates in the ultrasonic region, on the order of 20,000 times per second. Such a probe is brought into direct contact with the lens, and the vibrations are used to break up, or emulsify, the lens material. This lens material or cataract debris is then withdrawn from the eye through means of suction devices or the like. Fluid flushing means is provided adjacent the needle for the inflow of fluid into the eye in order to prevent collapse of the eye and to cool the vibrating needle and the area in contact with it.
This method suffers from a number of disadvantages. First, the nucleus may fragment, causing corneal damage, or the nucleus may be too hard to emulsify. The probe generates substantial risk of significant damage in various portions of the eye, if inadvertently brought into contact therewith, causing many surgeons to be reluctant to utilize the phaeco-emulsification technique. Second, rupture of the posterior capsule can occur easily with ultrasonic devices. Third, a great deal of manual dexterity and skill on the part of the surgeon are required to properly perform the operation. Fourth, a large amount of irrigation, or fluid exchange, is required in the anterior segment, greatly increasing the chances of corneal damage. And fifth, the likelihood of iris injury is high. As a result, while phaeco-emulsification does offer many advantages over former surgical methods, it is still not fully accepted, nor is it completely advantageous.
Conventional laser tools have been utilized in the past in surgical applications, but they have required remote energy sources. Typically, a relatively high power laser source communicates with the hand held tool by means of an articulated arm arrangement or the like. Unfortunately, this arrangement can be awkward for surgical applications and results in a loss of considerable laser energy during transmission of light to the hand piece.
What has been needed has been a method for cataract removal which does not involve a vibrating probe or an articulated arm arrangement, and which is substantially free of the inconveniences and problems associated with these methods, but which otherwise utilizes the advantages of a microsurgery technique. Further, what has been needed has been an apparatus for application of the needed method.